Implant Dentistry

5 Lecture’s Summary
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“Anyone who says he can see through women is
missing a lot.”
- Groucho Marx
 Divisions of Available Bone

Wolff’s Law: -

 According to mathematical rules every change in the form and function of bone is followed by
certain definite changes in: -
1- External Bone Conformation
2- Internal Bone Architecture

External Bone Conformation: -

 Quantity, Volume and Thickness

 Its three dimensions are: -
A- Width → Buccal to Lingual
B- Height → Coronal to Apical
C- Length → Mesial to Distal
 The Width is the most important dimension, and it’s measured via a C.T. Scan
 The Amount of bone around the tooth: -
o 0.5 mm from the Buccal and Lingual → The least amount
o 5.0 mm from the Buccal and Lingual → The proper “safest” amount
o 30 mm from the Buccal and Lingual → Oh My God it’s an Elephant!
 Dehiscence → Bone resorption from the CEJ “in normal teeth” or the crest module “In implants”
to the apical side
 The Height: -
o Maintain 1.5 mm at least between Implants and adjacent landmarks
o The Magnification factor in the panoramic radiograph is 1 – 1.6 mm
 The Length: -
o It’s the Edentulous Residual Ridge span
o One Crown → 5 – 8 mm
o Two Crowns → 15 mm
 Crown to Implant ratio: -
o It’s usually 1:2 (<1)
o Derived from the Height
 Angle: -
o The degree between the occlusal plane and the Implant body
o Wide Ridge → The Maximum Angle is 30 Degrees
o Narrow Ridge → The Maximum Angle is 20 Degrees
o Derived from the Width
 Classification of the Bone according to its Dimensions: -
o Division A: -
 Width → ≥5 mm
 Height →10 – 12 mm
 Angle → < 30 Degrees
 Crown to Implant Ratio → <1
 Length → ≥ 5 mm
o Division B “Classical”: -
 Width → 4 – 5 mm
 Height → 10 – 12 mm
 Angle → < 20 Degrees
 Crown to Implant Ratio → <1
 Length → > 15 mm
o Division B – W “Width”: -
 Width → 2.5 – 4 mm
 Height → 10 – 12 mm
 Angle → < 20 Degrees
 Crown to Implant Ratio → <1
 Length → > 15 mm
o Division C – W “Width”: -
 Width → < 2.5 mm
 Height → 10 – 12 mm
 Angle → None
 Crown to Implant Ratio → ≥1
 Length → Partial tooth loss
o Division C – H “Height”: -
 Width → Reduced
 Height → ≤ 10 mm
 Angle → None
 Crown to Implant Ratio → >1
 Length → Partial tooth loss
o Division D: -
 Width → Reduced
 Height → ≤ 10 mm
 Angle → None
 Crown to Implant Ratio → >5
 Length → Edentulous
 Determinants of Available Bone: -
A- Implant Platform
o Every increase in the platform diameter of around 0.25mm would increase the surface
area by around 10%
B- Implant Length
o Every increase in the length of around 3mm would increase the surface area by around
10%

 The Width is more important than the Height by 12 times

 Management of Reduced Width: -

1- Osteoplasty
2- Grafting For Division B – W “Width”
3- Narrow Implant

o Osteoplasty → Surgical resection of bone to increase the available width on the expense
of height
o Osteoplasty shouldn’t be performed in the esthetical areas
o Grafting → Requires more healing time (4-6 months)
o Narrow Implant → Will result in: -
1- Increase incidence of fatigue fracture if abutment or post
2- Poor emergence profile (Collection of Plaque)
3- Greater stress in the crestal region of bone (Twice as much)
4- Three times the lateral load of Division A Implants
5- More difficult maintenance due to poor contour
6- Attempt to strengthen narrow diameter implants resulting in compromised implant design
7- Load angle must remain less than 20 Degrees
8- Increase cost to both the Operator and the Patient
9- Two implants often required for proper prosthetic support

 The Smallest Implant diameter allowed is 3.0 mm

 The Lowest Implant Height allowed is 10 mm, unless the platform’s diameter was increased
then the height can be reduced safely
 Panoramic Radiograph is the most common tool to determine bone volume
  Management of Reduced Width: -
1- Osteoplasty
2- Root Form Implant
3- Subperiosteal Implant
4- Augmentation For Division C – W “Width”
5- Ramus Form Implant
6- Transosteal Implant

Internal Bone Architecture: -

 Quality, Density and Strength

 Bone Density is a key to determine the success of the implant
 The Highest Amount of Compact bone in the mouth is present in the Lower Anterior Region
 Anterior Mandible → 10% greater success rate compared to Anterior Maxilla
 Posterior Maxilla → Highest failure rate
 The Success of the implant from the most to the least successful: -
o Anterior Mandible → Posterior Mandible → Anterior Maxilla → Posterior Maxilla

 Modeling: -
o Has independent sites of formulation and resorption
o Change in Shape + Change in Size
 Remodeling: -
o Physiological process where there is resorption and formulation at the same site
o Replaces existing bone

 Stress → Force/Area
 Strain → Change in Length/Original Length
o The Greater the stress → The Greater the strain observed
o Micro-strain is the unit used to measure the Bone Density
 Frost’s Four Zones of Mechanical adaptation to strain for Compact Bone: -
1- Acute Disuse Window → 0 – 50 Microstrain → Resorption more than Formation
2- Adapted Window → 50 – 1500 Microstrain → Resorption equals Formation
3- Mild Overload Zone → 1500 – 3000 Microstrain
4- Pathologic Overload Zone → > 3000 Microstrain
 Bone Classification schemes related to Implant Dentistry: -
A- Quality 1 → Homologues Compact Bone
B- Quality 2 → Thick layer of Compact Bone surrounded by a thin layer of Spongy Bone
C- Quality 3 → Thinner layer of Compact Bone surrounded by a thicker layer of Spongy Bone
D- Quality 4 → Very Thin layer of Compact Bone surrounded by a thick layer of Spongy Bone

 Bone Density Classification: -

o Classified According to Different types of Wood
o It’s the same classification as the previous one, but compared to wood for better
understanding
A- D1 → Oak and Maple
B- D2 → White Pine and Spruce
C- D3 → Balsa
D- D4 → Styrofoam
o The Anterior Mandible → D1 & D2
o The Posterior Mandible → D2 & D3
o The Anterior Maxilla → D3
o The Posterior Maxilla → D4
The End